Chapter

Pathophysiology of neuropathic pain

Catherine E. Urch

in Neuropathic Pain

Second edition

Published on behalf of Oxford University Press

ISBN: 9780199563678
Published online May 2011 | e-ISBN: 9780199607426 | DOI: http://dx.doi.org/10.1093/med/9780199563678.003.0002

Series: Oxford Pain Management Library

Pathophysiology of neuropathic pain

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• Noxious stimuli are coded and transmitted via A and C primary afferent neurons in the periphery to the dorsal horn of the spinal cord • In the dorsal horn, transmission of noxious stimuli involves the neurotransmitters glutamate and substance P, but input can be inhibited or amplified by other influences • Damage to peripheral nerves can result in reduced firing thresholds, ectopic discharges, and cross-talk (activation of adjacent normal nerves) • Abnormal peripheral input or direct damage to the central nervous system leads to hyperexcitability and loss of inhibition • Neuropathic pain states can impact on control of descending inhibitory pathways from higher brain centres.

Pain arising after nerve injury or damage is a challenge to both clinicians and scientists. In other areas of nerve damage, sensory loss is expected, such as with vision. However, the question is when neuronal damage is inflicted on nociceptive neurons, why is there both loss, in the form of numbness, and abnormal gains in the form of pain and hyperalgesia?

Chapter.  2422 words.  Illustrated.

Subjects: Anaesthetics ; Pain Medicine

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